title: Sorafenib treatment is save and may affect survival of recurrent hepatocellular carcinoma after liver transplantation.
abstract: BACKGROUND
  Recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) is a rare but challenging condition. In most cases, the recurrent tumor is presented with extrahepatic spread. Therefore, systemic treatment with sorafenib has to be assessed. Because of a plethora of possible drug interactions, e.g., with immunosuppressant or anti-infective therapy, safety and feasibility of sorafenib treatment requires special attention.
  
  
  METHODS
  We retrospectively analyzed 18 patients who suffered from recurrent advanced HCC after LT between January 2002 and December 2010 at the University Hospital Heidelberg regarding safety of sorafenib treatment and survival.
  
  
  RESULTS
  Results showed that 8 patients were eligible for treatment with sorafenib showing a median time to progression (TTP) of 4.5 months and an overall survival of 9 months. Most common side effects were grades I and II diarrhea and hand-foot syndrome (HFS) which could be managed by sorafenib dose reduction. No grade III or IV adverse events (AEs) were noticed. No patient had to discontinue treatment due to AEs. The ten patients not amenable for sorafenib treatment, due to initial poor performance status or its deterioration after first line treatment, were treated with surgical resection (n = 3), locoregional therapies (n = 1), or palliative radiation therapy (n = 1). They showed a median overall survival of 2.3 months.
  
  
  CONCLUSIONS
  Sorafenib may represent a therapeutic option for recurrent HCC after LT with manageable side effects. The clinical benefit of sorafenib in this setting is promising but needs to be confirmed in a prospective randomized trial.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Pfeiffenberger
authors.forename: Ronald
authors.initials: R
authors.lastname: Koschny
authors.forename: Katrin
authors.initials: K
authors.lastname: Hoffmann
authors.forename: Arianeb
authors.initials: A
authors.lastname: Mehrabi
authors.forename: Anne
authors.initials: A
authors.lastname: Schmitz
authors.forename: Boris
authors.initials: B
authors.lastname: Radeleff
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.forename: Tom M
authors.initials: TM
authors.lastname: Ganten
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D009536:Niacinamide / Q000031:analogs & derivatives* / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use*; D011183:Postoperative Complications; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D000077157:Sorafenib; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D020123:Sirolimus